Information Collection

SEED - Clinic Visit- Case Child

IC 178555 under ICR 200709-0920-004 · OMB 0920-0741.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0741 can be found here:

Documents and Forms

Document Name Document Type
Form No number SEED - Clinic Visit- Case Child Form and Instruction
No number Appendix G.1 ADOS Appendix G.1 ADOS.pdf Form and Instruction
Appendix G.2 Mullen Appendix G.2 Mullen.pdf Form and Instruction
appendix P Dysmorphology Exam appendix P Dysmorphology Exam.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SEED - Clinic Visit- Case Child	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	No number	Appendix G.1 ADOS	Appendix G.1 ADOS.pdf	Yes	Yes	Fillable Printable
Form and Instruction	None	Appendix G.2 Mullen	Appendix G.2 Mullen.pdf	Yes	Yes	Printable Only
Form and Instruction	None	appendix P Dysmorphology Exam	appendix P Dysmorphology Exam.doc	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 1,134	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,430	2,430
Annual IC Time Burden (Hours)	1,351	1,351
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.